Abstract

P 111

The feasibility of endoscopic cyclophotocoagulation in the management of intractable glaucomas

Matthias Neuburger, Daniel Böhringer, Thomas Reinhard, Jens Jordan
Universitäts-Augenklinik Freiburg

Objective
Cyclodestructive laser procedures are commonly used as last resort for the treatment of intractable glaucomas. Endoscopic cyclophotocoagulation (ECPC) is a relatively new method that enables a selective destruction of the ciliar body processes under direct visualization. This study aimed to retrospectevely evaluate the feasibility of this method to effectively lower intraocular pressure (IOP) in a mixed population of patients with refractory glaucomas.
Methods
We analyzed the data of endoscopic cyclophotocoagulations performed during the past three years at our hospital (diode laser, λ= 810nm) We were able to include data from 25 eyes of 25 patients with the following diagnosis: 14 traumatic glaucomas, 3 open angle glaucomas, 3 congenital glaucomas, 2 uveitic glaucomas, 1 angle closure glaucoma, 1 juvenile glaucoma, 1 Peters anomaly. Success was definded as an IOP below 21mmHg and/or a IOP reduction from baseline by 30%.
Results
Mean IOP before surgery was 32.7 mmHg (±8.0mmHg) under maximum medical treatment. During treatment, a mean of 24 laser spots were applied in each eye (mean 0.5 sec, 700 mJ). On the first postoperative day, mean IOP was 19.5mmHg (±7.9 mmHg). At the next visit after mean 10.2 days (±10.5 days), IOP had increased up to mean 28.2 mmHg (±10.7 mmHg). The Kaplan-Meier-cumulative survival analysis for all patients revealed a success rate of only 15% after 50 days. Only in the traumatic glaucoma subgroup, 26% of the patients could be classified as success after 50 days. Intraocular, inflammatory signs wered recorded in 3 patients, postoperative IOP-peaks were noted in 4 patients as the major complications.
Conclusions
In our study, we found the ECPC not to be an effective procedure for the treatment of refractory glaucomas. As the ECPC is a surgically invasive method, the possible superiority of the non-invasive, diaphanoscopically controlled, transscleral CPC needs further evaluation. Furthermore, possible modifications and augmentation protocols of the energy-level applied by ECPC will need further investigation.

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